Summary
UnitedHealthcare's November 2026 Medicare Advantage medical policy update for Tier 2 Molecular Pathology Procedures changes the applicable codes and removes diagnosis code Z59.7 from the non-covered diagnosis list. Billing teams should review claims for these molecular pathology procedures against the updated applicable codes and diagnosis edits.
Get alerts when payers change rules like this one
We check UnitedHealthcare and other payers every day and email you when a change matches your specialty and state.
Get UnitedHealthcare alertsPolicy Monitoring is free. No card required.
What to do
Action · 2 steps
01Already effective 2026-11-01: Billing team should review charge entry and claim edits for Tier 2 molecular pathology procedures on Medicare Advantage claims, confirming the updated applicable codes are used and that Z59.7 is no longer treated as a non-covered diagnosis in the claim scrubber.
02Pathology and ordering providers should be told that Z59.7 has been removed from the non-covered list, and the team should check the full policy text for the specific applicable codes before submitting molecular pathology claims.
Codes mentioned
Z59.7
Original notice
Tier 2 Molecular Pathology Procedures
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →Radiologic Diagnostic ProceduresMediumEffective Dec 1, 2026 · Medical PolicyMolecular Pathology/Genetic Testing Reported with Unlisted CodesMediumEffective Nov 1, 2026 · Medical PolicyClinical Diagnostic Laboratory ServicesHighEffective Nov 1, 2026 · Medical PolicyBrowse every UnitedHealthcare change in the policy list